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Emergency Medical Services at the Crossroads
not all local EMS providers agree that newer, more sophisticated technology necessarily translates into better or more efficient patient care. The end result is that the infrastructure supporting EMS personnel across the country is highly variable and uneven. In many areas there is a growing gap between the type of equipment now available and that which is actually in use. This chapter details key areas in which technology can play a role in supporting effective EMS response: emergency notification and dispatch, equipment for emergency response, and communications and data systems.
EMERGENCY NOTIFICATION AND DISPATCH
The development and implementation of a single nationwide number to call in emergency situations was a major advance for the U.S. emergency and trauma care system. Before 9-1-1 was fully adopted, states and localities had in place a vast array of 7-digit telephone numbers for citizens to call in the case of an emergency. In the early 1970s, for example, Nebraska had 184 different ambulance service phone numbers in use in various parts of the state (NAS and NRC, 1978; IOM, 1993). Designating a simple 3-digit, standardized number to call in emergencies helped avoid the confusion and delays that inevitably occurred with having so many different numbers for so many different types of emergencies in various parts of the country.
One of the early catalysts for the development of the 9-1-1 system in the United States occurred in 1957 when the National Association of Fire Chiefs recommended the use of a single number for reporting fires. In addition, the 1966 report Accidental Death and Disability contained a recommendation that there be “active exploration of the feasibility of designating a single nationwide telephone number to summon an ambulance” (NAS and NRC, 1966).
In 1967, a presidential commission recommended that a uniform number be used to reach emergency response agencies. The following year, AT&T announced that it would establish 9-1-1 as the emergency code throughout the United States. The first 9-1-1 call was placed in February 1968 (NENA, 2004). In 1973, the Department of Transportation recommended that the universal emergency number be 9-1-1 and provided model legislation for states to use in implementing this system (DOT Wireless E9-1-1 Steering Council, 2002). Implementation of the 9-1-1 system occurred very unevenly across the country, however. By 1992, a number of states, including California and Connecticut, had 100 percent of their populations covered by a 9-1-1 system. In that same year, however, other states had less than 50 percent access, while some, including Maine and Vermont, had only 25 percent coverage (IOM, 1993). Such disparities in the management of 9-1-1 systems nationwide persist today.
To improve federal coordination and communication on 9-1-1 activities,